Respiratory Management of the Extremely Premature Infant

Advancements in the fields of obstetrics and neonatal medicine, notably the use of antenatal corticosteroids and exogenous surfactant, have significantly improved the chances of survival for babies born prematurely. Extremely premature infants, born before 28 weeks of gestation, have underdeveloped lungs and pulmonary vasculature, necessitating a carefully tailored respiratory management strategy that incorporates both noninvasive and invasive methods throughout their NICU stay. The primary goal of respiratory management in this cohort is to provide the least amount of support necessary while oxygenating and ventilating the lungs. Noninvasive ventilation (NIV) methods are preferred to invasive methods to minimize the risk of damaging the lungs from mechanical ventilation. Nasal continuous positive airway pressure, high-flow nasal cannula, noninvasive positive pressure ventilation, noninvasive neurally adjusted ventilatory assist, and noninvasive high-frequency oscillatory ventilation are the types of NIV most readily available for use in extremely premature infants. Invasive methods such as conventional mechanical ventilation, high-frequency oscillatory ventilation, high-frequency jet ventilation, and neurally adjusted ventilatory assist are used to manage these fragile infants when intubation is required. Despite attempts to use noninvasive methods, many extremely premature infants may still require intubation. The main goal remains to improve outcomes while minimizing risks, although bronchopulmonary dysplasia still remains a challenge. Ongoing research and a consistent approach are essential for enhancing outcomes for these babies.